Hall Ticket No:

College Code
JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY:
KAKINADA
Kakinada 533 003 A.P. (India)
APPLICATION FOR AWARD OF DEGREE
(To be en! !o !"e Con!#o$$e# o% E&a'ina!ion( )NT*K( Kakinada 533 003.
D.D. No+ D!.+
,ank+ A'o-n! R.+
In Con.o/a!ion (in Aben!ia)
P#e Con.o/a!ion (Ti/k 012 !"e a33#o3#ia!e bo&
Po!4 Con.o/a!ion
A%%i& a #e/en!
Pa3o#! 5i6e
P"o!o7#a3"
Na'e in ,$o/k
Le!!e#(A !e" SSC)
Fa!"e#8 na'e in
,$o/k Le!!e#
Add#e %o#
Co''-ni/a!ion (Do no!
#e3ea! 9o-# na'e)
Co#tact No+ Pin Code+
De7#ee !o be A:a#ded
De7#ee
,#an/"
Da!e+ SIGNATURE O$ THE CANDIDATE
P$a/e+
1/4
(To %e &illed i# %' t(e O&&ice o& t(e Co#t"olle" o& E)a*i#atio#+ JNTUK+ Kaki#ada,
T"e Candida!e "a %-$%i$$ed a$$ !"e a/ade'i/ #e;-i#e'en! %o# !"e a:a#d o%
De7#ee in . T"e Candida!e "a e/-#ed
C$a +
Da!e + CONTROLLER OF E<A=IANTION5
-To %e &illed i# %' t(e O&&ice o& t(e Regit"a"+ JNTUK+ Kaki#ada)
>. T"e a:a#d o% De7#ee !o !"e a33$i/an! :a endo#ed b9 !"e A/ade'i/ 5ena!e a! i! 'ee!in7 "e$d
on
?. T"e E&e/-!i.e Co-n/i$ a33#o.ed !"e a:a#d o% De7#ee !o !"e a33$i/an! a! i! 'ee!in7 "e$d
on
3. De7#ee bea#in7 n-'be# :a a:a#ded !o !"e a33$i/an! a! !"e
Con.o/a!ion "e$d on
@. De'and d#a%! en!e#ed in !"e D.D. Re7i!e# a! Pa7e No. on
5. T"e De7#ee /e#!i%i/a!e 'a9 be i-ed.
Da!e + REGI5TRAR
T"e De7#ee Ce#!i%i/a!e bea#in7 No. i Di3a!/"ed on .
Di3a!/"in7 C$e#k( )NT*K( Kakinada.
2/4
$OR !OSTAL USE ONLY:
LA.ELS $OR !ER/ANENT ADDRESS -W"ite i# CA!ITAL LETTERS ONLY,
No!e+ A 9o-# De7#ee :i$$ be en! b9 3o!( :#i!e 9o-# %-$$ add#e nea!$9 and $e7ib$9.
4444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444444
$OR !OSTAL USE ONLY:
LA.ELS $OR !ER/ANENT ADDRESS -W"ite i# CA!ITAL LETTERS ONLY,
No!e+ A 9o-# De7#ee :i$$ be en! b9 3o!( :#i!e 9o-# %-$$ add#e nea!$9 and $e7ib$9.
3/4
HTNO :
NA/E :
$ATHER0S NA/E :
E/AIL ID :
CONTACT NO :
ALT1 CONTACTNO :
ADDRESS :
!INCODE :
A%%i& one 'o#e P"o!o7#a3" "e#e A W#i!e !"e Ba$$!i/ke! No on !"e ba/kide o% P"o!o7#a3"
4/4
HTNO :
NA/E :
$ATHER0S NA/E :
E/AIL ID :
CONTACT NO :
ALT1 CONTACTNO :
ADDRESS :
!INCODE :
Lit o& co2ie to %e e#cloed to t(e a22licatio# &o" 2"ocei#g OD
>. DD in %a.o-# o% t(e Regit"a"+ JNTUK+ Kaki#ada 3a9ab$e a! Kakinada.
(Na'e and B.T. N-'be# "a$$ be :#i!!en on !"e ba/k ide o% De'and d#a%!)
Fee in/$-i.e o% Po!a7e +
a) In Con.o/a!ion (In Aben!ia) : R 345561
b) P#e4Con.o/a!ion + R. 7+45561
/) Po! Con.o/a!ion + R8 3455C4 D ( La!e %ee o% R8 45561 3e# e.e#9 9ea#).
955: 3aed o-! ba!/"+ R87+455 (R. >500C4 D La!e %ee o% R. ?000C4 )
9535 3aed o-! ba!/"+ R87+555 (R. >500C4 D La!e %ee o% R. >500C4 )
9533 3aed o-! ba!/"+ R89+455 (R. >500C4 D La!e %ee o% R. >000C4)
9539 3aed o-! ba!/"+ R89+555 (R. >500C4 D La!e %ee o% R. 500C4)
?. A!!e!ed /o3ie o% 55C( P#o.iiona$ /e#!i%i/a!e.
3 a) A!!e!ed /o39 o% /ono$ida!ed 'a#k 'e'o (C==) (%o# ,.Te/" C ,.P"a#'a/9 /o-#e).
b) A!!e!ed /o3ie o% indi.id-a$ e'e!e# 'a#k 'e'o.
@ T;o 2a2o"t i<e 2(otog"a2( in a e3a#a!e /o.e# and 3in !"e /o.e# !o !"e a33$i/a!ion. T"e
B.T No "o-$d be in.a#iab$9 :#i!!en on !"e #ea#ide o% !"e 3"o!o7#a3".
5. T"e 5!-den! Na'e and Fa!"e#8 Na'e in !"e P#o.iiona$ /e#!i%i/a!e '-! be :#i!!en a 3e# 55C.
E. I% !"e#e i 'i!ake in !"e PCCC==( !"e /e#!i%i/a!e a#e !o be /o##e/!ed %i#! and !"e /o##e/!ed
/o3ie o% PCCC== a#e !o be en/$oed.
F. In /ae !"e %i$$ed in a33$i/a!ion i end b9 !"e 3o!( :#i!e GOD4APPLICATIONG on !"e !o3 o%
!"e /o.e#.
H. I% !"e9 %ai$ !o %-$%i$$ an9 o% !"e #e;-i#e'en! !i3-$a!ed abo.e( !"e OD A33$i/a!ion :i$$ no! be
3#o/eed.
I. T"e OD /e#!i%i/a!e :i$$ be 3o!ed !o !"e add#e %-#ni"ed b9 !"e !-den! and "en/e /o'3$e!e
in%o#'a!ion need !o be 3#o.ided.
P$a/e +
Da!e + 5IGNAT*RE OF TBE CANDIDATE
5/4